POLICE OFFICER (RECRUIT) EMPLOYMENT APPLICATION · Date From To METRO VANCOUVER TRANSIT POLICE POLICE OFFICER (RECRUIT) – EMPLOYMENT APPLICATION In chronological order, starting

Applicant

METRO VANCOUVER TRANSIT POLICE

POLICE OFFICER (RECRUIT) – EMPLOYMENT APPLICATION

The information you provide in this application form will be used to determine whether you would be capable of meeting this Department’s requirement for employment as a Police Officer.

It is important you answer each question accurately. False, incomplete or incorrect information could result in your disqualification from the selection process. Information provided or collected will be held in confidence and will be subject to applicable privacy legislation.

Instructions • Ensure you meet the minimum requirements:

- Minimum 19 years of age - Canadian Citizen or Permanent Resident - Physically fit and in excellent health - Grade 12 diploma; consideration given for GED and work experience - No criminal convictions for which a pardon has not been granted - No adult criminal charges pending - A valid Class 5 driver's license with a good driving history - Type a minimum of 25 words per minute - Meet the Transit Police vision acuity and hearing standards

• Please read all the questions carefully and answer every question.

• If the question is not applicable, indicate by N/A. • Complete forms electronically or in pen. • All sections of the Application Questionnaire must be completed and all forms must be completed fully and

submitted with application.

Form 1: Consent for Collection & Use and Disclosure of Personal Information (AZ190) Form 2: POPAT Liability Release & Indemnity (AZ180) Form 3: Physical Abilities Test Medical Examination Waiver (AZ160) Form 4: Vision Report for Police Service (AZ030)

For your application to be considered, copies of the following documents must be submitted with this application:

• Birth Certificate • Canadian Citizenship or Permanent Resident Status documentation

• Driver’s License • Two (2) color passport photos- to be mailed in or delivered • Drivers Abstract (obtained from Motor Vehicle Branch) • Valid First Aid Certificate - CPR level C • Certificate of keyboarding skills (obtained from an accredited learning institution). Online typing test results are not acceptable. • High School Graduation Transcripts • Post-Secondary School transcripts(minimum 30 credits required), if applicable

Education completed outside of Canada must be evaluated by the International Credential Evaluation Service. • If you have completed an Ethos entrance exam with any other municipal police agency in BC, please attach the document from

that police agency showing your exam results • If you have completed the POPAT with any other municipal police agency within the last 12 months, please attach the supporting

documents • If you have ever been deferred by any other police agency, please provide a copy of all deferral letters or emails

Please mail or drop off completed application package to:

Recruiting Section Metro Vancouver Transit Police (SCBCTAPS) 300-287 Nelson's Court, New Westminster, BC V3L 0E7

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IMPORTANT: 1: Carefully review and follow application instructions.

2: Please complete fully and use additional paper if space is insufficient.

PERSONAL INFORMATION

Surname: Given (1): Given (2):

Mr. Ms. Mrs. Miss City: Province:

Address: Home Phone #: Cell Phone #:

Postal Code: Email Address:

Height: ft in cm Weight:

lbs

kg Second Language:

Hair Color: Blood Type: Eye Color: Handed: Left Right

Date of Birth: Place of Birth: SIN:

Marital Status: Single Married Divorced Separated Widow(er) Common-Law

Yes No

Are you at least 19 years of age?

Are you legally eligible to work in Canada?

Are you a Canadian citizen or Permanent Resident?

If you are a Permanent Resident, please provide your PR number. PR Number:

What date did you become a Permanent Resident of Canada? Date:

Have you ever been charged with a Federal, Provincial or Municipal offence? (This means any fine, period of imprisonment or period of probation offered by the court; other than minor driving offences.)

If a Criminal Pardon has been granted, please attach a copy of the Pardon to this application.

If you have answered Yes to this question, please complete the next page outlining the date and particulars of each charge and/or conviction.

Note: Conviction of an Offence does not necessarily preclude consideration for the position of Police Officer.

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Additional space (if required)

CRIMINAL CHARGES AND/OR CONVICTIONS

1

2

3

4

5

6

7

8

9

10

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Provide full information (including maiden or married name if applicable)for your current spouse/partner, all former spouse(s)/partners, common-law, sons, daughters, father, mother, brothers, sisters and their spouses/partners.

Surname Given 1 Given 2 Relationship

Mr. Ms. Mrs. Miss Date of Birth: Phone:

Address:



Address:



Address:



Address:



Address:

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Additional space (if required)



Address:



Address:



Address:



Address:



Address:

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Date

From To



In chronological order, starting with your current address, list all residences where you have lived as an adult (including any out-of-country residences).

Address City/Province/State Country

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Please list all investment or recreation property.

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Address City/Province/State Country Date

From To

1

2

3

SOUTH COAST BRITISH COLUMBIA TRANSPORTATION AUTHORITY POLICE SERVICE


EDUCATION

Secondary School attended:

Highest grade completed: Year completed: Program completed:

Secondary School Attended:

Highest grade completed: Year completed: Program completed:

Community College attended:

Course name: Length of Course: Credits obtained:

Certificate or Diploma awarded:

Dates From: To: Studied Full time Part time

Community College attended:

Course Name: Length of Course: Credits obtained:

Certificate or Diploma awarded:


University attended:

Major area of study: Length of Course Credits:

Degree awarded:


University attended:

Major area of study: Length of Course Credits:

Degree awarded:


Business, Trade or Technical School attended:

Course name: Length of Course: Credits

License, Certificate or Diploma awarded:


Business, Trade or Technical School attended:

Course name: Length of Course: Credits

License, Certificate or Diploma awarded:


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SOUTH COAST BRITISH COLUMBIA TRANSPORTATION AUTHORITY POLICE SERVICE


Other relevant Educational Courses, Workshops, Seminars, Training, Licenses, Certificates:

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EMPLOYMENT HISTORY

Note:

1. Beginning with your present employer, please list every position you have held (to the best of your knowledge). If you have held two or more positions with the same employer, list each position separately. Please include any military or volunteer work. (If more space is required, please provide further details on a separate sheet of paper)

2. Please be advised that we may contact your current employer.

Present employer:

Telephone# ( ) Date of employment From: To:

Employer address:

Supervisor’s name and title: Your title:

Brief description of your duties:

Have you ever been disciplined or reprimanded with this employer? If so, provide brief details.

What did you like best about your work?

What did you like least about your work?

Reason for leaving?

How many times have you called in sick to work with his employer? If unknown, provide an approximate amount.

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(2) Previous employer:


Employer address:



Have you ever been disciplined or reprimanded? If so, provide brief details



Reason for leaving?

How many times have you called in sick to work with this employer? If unknown, provide an approximate amount.

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(3) Previous employer:


Employer address:



Have you ever been disciplined or reprimanded? If so, provide brief details.



Reason for leaving?

How many times have you called in sick to work with this employer? If unknown, provide an approximate amount.

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VOLUNTEER HISTORY

Telephone# ( ) Date of volunteering From: To:

Employer name:

Employer address: Number of volunteer hours:

Supervisor’s name and title:

Your title and description of duties:



Reason for leaving?

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MEDICAL

Yes No

Do you wear corrective lenses?

Are you aware of any deficiencies with your color vision?

Have you ever had corrective eye surgery? If yes, provide date and location

(yy/mm/dd) Location:

Are you aware of any problems with your hearing? If yes, please provide a brief explanation.

Have you ever had a broken bone? If yes, briefly state when and what kind of injury.

Have you experienced any type of illness, injury or accident which has caused a temporary or permanent effect on your lifestyle? If yes, please briefly explain.

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Yes No

Are you currently being treated for any medical conditions? If yes, please provide details.

List all prescription and non-prescription medication you are currently taking. Please give details.

Are you physically fit?

How do you maintain your fitness?

Name and address of your Family Physician:

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DRIVER’S LICENCE INFORMATION

Driver’s License Number Class Province of Issue Expiry Date (Y/M/D)

List ALL driving offences below, Including warnings or disputed tickets. Please provide a brief explanation of each offence in the space provided on the next page.

Date Offence Location

Does your Driver’s License permit you to drive an automobile in British Columbia with full driving privileges? Yes No

Has your Driver’s License ever been suspended, revoked or placed on Probation? No

Explanation:

Do you have any demerit points on your Driver’s License? If yes, how many? Yes No

Explanation:

List all Provincial and Municipal tickets/fines you have been issued (liquor, bylaw, parking, etc). Provide a brief explanation on the next page in the space provided.

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Offence Information

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FINANCIAL

Yes No

Have you ever declared bankruptcy, filed a consumer proposal or been contacted by a debt collection agency?

Explanation:

Have you ever written an NSF Cheque? If yes, please provide brief details.

Explanation:

Do you own your home?

What is your monthly rental or mortgage payment?

What is your current net income per month? $

Have you ever had a problem with managing finances?

Explanation:

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List all your assets (i.e., home, vehicle, personal effects, investments, savings, etc.)

Assets Value $

Total

List all of your debts (i.e., mortgages, loans, credit cards, lines of credit, etc).

Debts Original Amount Current Amount Monthly Payment

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GENERAL INFORMATION

Name three things you have done that you are most proud of:

1.

2.

3.

What are your plans for the future?

What actions have you taken to implement your plan?

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What Internet sites do you frequently visit and what on-line social media do you use?

Yes No

Do you correspond with or visit your parents?

Do you correspond with or visit your siblings?

At what age did you leave home? Age

What activities do you share with your family?

Are you proficient in any other languages other than English? If yes, please specify.

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Have you ever applied for a position as a Police Officer with any other Police Agency? If yes, please list and provide a brief explanation of the status of your application(s). Please attach any documentation you have received in regards to your application being closed or deferred.

Agency Date of Application (Y/M/D)

Position Applied For Status of Application

What association have you had with Police Officers or police work?

Have you served in a Police Service or the Armed Forces of any country? If yes, please provide details.

List all members or employees you know of, or who may know of you, that work or previously worked at Transit Police.

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How did you hear about Transit Police? Newspaper Radio Internet Job Fair Other: _

Detail your reasons for wishing to become a member of the Transit Police:

I hereby certify the answers given by me in this questionnaire are true and complete. I agree and understand that if any answers and material facts are found to be false or omitted, it will cause forfeiture on my part of all rights to employment with the South Coast British Columbia Transportation Authority Police Service. I also understand that any information obtained during the selection process may be available to other police agencies in Canada. I am also aware that as a South Coast British Columbia Transportation Authority Police Service applicant, I will be required to complete a polygraph test.

Signature of Applicant Date(Y/M/D)

Name of Applicant

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ADDITIONAL SPACE (if required)

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VISION REPORT FOR POLICE SERVICE (AZ030)

TO BE COMPLETED BY THE APPLICANT

Name of Applicant:

Surname Given Name Initial

Address of Applicant:

Street

City Province PostalCode

Have you ever had eye surgery? Yes No If yes, indicate the date and type of procedure:

TRANSIT POLICE VISION STANDARDS FOR EMPLOYMENT (but not required)

Uncorrected Vision No less than 20/40 in one eye and 20/100 in the other eye

Corrected Vision No less than 20/20 in one eye and 20/30 in the other eye

Color Vision Should be normal i.e., pass the Farnsworth D-15 test

Peripheral Vision 150 continuous degrees along the horizontal meridian binocularly, and 30 degrees above and below the fixation point

Binocular Vision Normal

TO BE COMPLETED BY THE ATTENDING OPTHAMOLOGIST / OPTOMETRIST

Date of examination:

YYYY/MMM/DD

1. Visual Acuity Without Visual Aid With Best Possible Corrections

Right Eye 20/ 20/

Left Eye 20/ 20/

Both Eyes 20/ 20/

2. Horizontal Field of Vision Temp Nasal

Right Eye

Left Eye

Binocular Vision(Depth Perception) Normal Abnormal

COMMENTS:

3. Colour Vision determined by Pseudo-Isochromatic Plates or Farnsworth-Munsell

Normal Abnormal

COMMENTS:

ATTENDING OPHTHALMOLOGIST / OPTOMETRIST

Name: Telephone:

Address:

Signature of Ophthalmologist/Optometrist Date (YYYY/MMM/DD)

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CONSENT TO COLLECTION, USE & DISCLOSURE OF PERSONAL INFORMATION (AZ190)

Pursuant to Sections 27(1)(a)(i), 27(2), 32(b) and 33.1(1)(b) of the Freedom of Information and Protection of Privacy Act, I,

(also or formerly known as)

of (Address)

DO HEREBY CONSENT to the collection, use and disclosure by the Metro Vancouver Transit Police (South Coast British Columbia Transportation Authority Police Service) and/or their agent(s) of the following personal information pertaining to me:

any and all records, files, notes, reports, opinions or other information concerning me, including information of the

following types:

Credit bureau check – including a review of the applicant’s credit rating

Bankruptcy search

Court registry search – including a search for any civil litigation, criminal and family matter proceedings at the

Supreme Court or Provincial Court

Motor vehicle driver abstract and ICBC claims history review

Verification of education

Neighborhood enquiries

Previous employment enquiries

Applicant interview

All Criminal Data Bases& Criminal Records Checks

I acknowledge that I have been advised that the said information is being collected; used and disclosed to assess my suitability

for employment with the Metro Vancouver Transit Police (SCBCTAPS) and that the collection of this information is authorized

by section 26(c) of the Freedom of Information and Protection of Privacy Act. I have been further advised that if I have any

questions regarding this collection, I can contact the Deputy Chief Officer, Metro Vancouver Transit Police (SCBCTAPS), 307

Columbia Street, New Westminster, BC V3L 1A7; Telephone: 604-515-8300.

This consent is freely given and, furthermore, I acknowledge that a photocopy of this signed release is to be considered as

valid as the original even if it does not contain an original of my signature.

Signature of Applicant Date(yy/mm/dd)

Name of Applicant

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P.O.P.A.T. LIABILITY RELEASE & INDEMNITY (AZ180)

We wish your participation in the “Run/P.O.P.A.T.” (Hereafter referred to as the “Test”) to be a safe and enjoyable experience but any such activity does involve risk! Please read carefully.

DISCLAIMER: The Metro Vancouver Transit Police (South Coast British Columbia Transportation Authority Police Service), the South Coast British Columbia Transportation Authority and the South Coast British Columbia Transportation Authority Police Service Board are not responsible for any injury, death, loss or damage suffered by any person participating in the Test, as conducted by the Metro Vancouver Transit Police (SCBCTAPS), for any reason whatsoever including negligence on the part of the Metro Vancouver Transit Police (SCBCTAPS), the South Coast British Columbia Transportation Authority, the South Coast British Columbia Transportation Authority Police Service Board, or any of their directors, officers, employees, agents, or representatives.

AGREEMENT: In consideration of the Metro Vancouver Transit Police (SCBCTAPS) and the South Coast British Columbia Transportation Authority allowing me to participate in the Test and any associated activity, I agree to RELEASE AND SAVE HARMLESS AND INDEMNIFY each of the Metro Vancouver Transit Police (SCBCTAPS), the South Coast British Columbia Transportation Authority, the South Coast British Columbia Transportation Authority Police Service Board, and their directors, officers, employees, agents, and representatives from and against all claims, demands, actions, costs and expenses, and from all claims or demands whatever in law or in equity, in respect to injury, death, loss or damage to my person or property whatsoever and howsoever caused, arising out of, or in connection with, my taking part in the Test and/or any associated activity, not with- standing that the same may have been contributed to or occasioned by any act or omission (including, without limitation, a negligent act or omission) of the Metro Vancouver Transit Police (SCBCTAPS), the South Coast British Columbia Transportation Authority, the South Coast British Columbia Transportation Authority Police Service Board, or their directors, officers, employees, agents, or representatives. I am aware of the risks inherent in participating in the Test and/or any associated activity. I further understand that the risks involved are also relative to my own state of fitness, health, awareness, and the skill and care with which I conduct myself during the Test. I voluntarily assume these risks and waive notice of all conditions, dangers or otherwise, in or about the Test. I agree to assume all risks involved before, during and after the Test. I agree that this Release shall bind my heirs, executors, administrators and assigns.

I, acknowledge having read this LIABILITY RELEASE AND INDEMNITY and I understand and agree to be bound by the conditions herein.

Signature of Participant Date(yy/mm/dd)

Name of Participant

Signature of Witness Date(yy/mm/dd)

Name of Witness

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Name of Applicant


PHYSICAL ABILITIES TEST MEDICAL EXAMINATION WAIVER (AZ160)

Address of Applicant

This person is an applicant for the position of Police Constable with the Metro Vancouver Transit Police (South Coast British Columbia Transportation Authority Police Service). He/she is required to perform a Police Officer’s Physical Abilities Test (POPAT). The POPAT is designed to simulate and measure an officer’s physical ability to respond to a critical incident and apprehend and/ or control a prisoner/suspect. The test was developed by exercise physiologists and is based on their research findings. Their research has identified that the usual physical components of a response to a critical incident may involve quick action in getting to the problem, intensive heavy work resolving the problem and then removing the problem. The test is conducted in a gymnasium and consists of running 400 meters (1/4 mile), which includes climbing up and down stairs, jumping over low obstacles, pushing/pulling heavy weights (80 lbs/37 kg) then lifting and carrying a “dead weight” of 100 lbs (45 kg) over a distance of 15 meters (50 ft.). It was found that most test participants experienced maximal heart rate during the test. This indicates brief (up to 4 minutes) but maximal stress being placed on the cardiovascular system. To minimize the chance in precipitating a major cardiovascular event, we are requesting that the person be examined to determine his/her employment and test risk potential.

In addition to your usual examination, we request your assessment of this person with respect to factors which may place him/her at risk during this test or during future police officer-related duties:

1. Hypertension with possible causative factors; 2. Diabetes Mellitus; 3. Known heart disease or symptomatic cardiovascular disease including Angina, breathlessness,

palpitations, edema, syncope, dizziness, etc.; 4. Low fitness level; 5. Acute systemic infections including viral respiratory infections;

6. Muscular and/or skeletal problems which may affect physical performance or present long-term limitations; 7. Any other areas of concern:

To be completed by examining physician:

Considering the fact that an applicant’s typical response to maximal testing may include fear and anxiousness due to anticipation,

does this applicant remain safe to perform the POPAT if their resting blood pressure and/or heart rate values exceed 144/94 mmHg

or 100 bpm, assuming the applicant is not exhibiting any signs of the following: chest, arm, neck and jaw pain; signs of light-

headedness, fainting and shortness of breath?

Yes No

In your opinion, based on the information provided to you and the results of your examination, is this person’s health at risk if they participate in the Police Officer’s Physical Abilities Test (POPAT)?

Yes No

COMMENTS:

Signature & Stamp of Medical Doctor Date(yy/mm/dd)

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Documents

POLICE OFFICER (RECRUIT) EMPLOYMENT APPLICATION · Date From To METRO VANCOUVER TRANSIT POLICE POLICE OFFICER (RECRUIT) – EMPLOYMENT APPLICATION In chronological order, starting